Transcription:

Melanie Cole (Host): Since the reports of recent news about the First Lady having a kidney embolization procedure come out, you might have wondered why or what that means for her health. My guest today, is Dr. Stephen Strup. He’s the James F. Glenn Professor and Chairman of Urology at The University of Kentucky Healthcare. Dr. Strup, before we start about embolization, give us a little physiology lesson. What do the kidneys actually do?

Dr. Stephen Strup (Guest): Well, the kidneys are a very vital organ. There are two of them, and most people are born with two. The kidneys filter blood and filter out a lot of the toxins in the blood, and the blood is filtered, and the by-product of that is urine. The filtering process of the kidney is critical, and if the kidneys fail, then often you need dialysis of some sort or a kidney transplant to help maintain those functions. The kidney has other issues — it also regulates blood pressure to some degree, and is again a very important structure.

Melanie: So, what would someone notice as symptoms of kidney issues. Would they see something in their urine? We know we get — in our blood tests, we get tests for certain urine issues. What would they notice? Would there be any symptoms or red flags?

Dr. Strup: Well, I think if you think of it, there’s really two classes of things that go on with the kidneys, and the first I would call medical-renal disease — diseases of filtering problems. If your kidney is not doing its job filtering, then a lot of those issues are going to show up in the bloodstream. Your creatinine level might be elevated; you might also be spilling protein in your urine. Those are just a couple of things that can lead one to a diagnosis of medical disease.

And then there are what I would consider structural problems with the kidney, and that would be renal masses, tumors, benign conditions that would lead one to have again a structural problem with the kidney. A lot of times, those are asymptomatic. They’re found incidentally; you may stumble on them getting a CT scan or an ultrasound for an entirely different problem — a stomach ache, let’s say. If you were to have symptoms from a structural problem like a mass or a tumor in the kidney, they may range from the classic, palpable mass or something they would feel or sense, to bleeding in the urine, or pain on that side. Those would be three examples of ways it might show up.

Melanie: If someone does have a structural issue with their kidneys, does that necessarily dictate that it is kidney disease, or no, sometimes these things can just show up?

Dr. Strup: Well, I think in terms of structural things in the kidneys, they range — and I tend to have people think of things as a spectrum. On one end of that spectrum, think of a cyst, which is a thin-walled structure that contains fluid — think of a water balloon — and half the people in the country have cysts on their kidneys. There is no rhyme or reason; there are some genetic diseases that predispose you to those, but having a cyst or two is a fairly common thing that most people just don’t know they have.

If you slide that scale all the way to the other side, then that would be a solid mass of the kidney, and those tend to be more concerning because they can — they take up blood supply, they’re a solid consistency, and a higher percentage of those are going to be potential cancers or tumors within the kidney. There are all sorts of things that happen, and the first thing we tend to do is figure out where on that scale that they are and how much we may be concerned they could represent a tumor or just a benign condition.

Melanie: If you do determine that there is a benign condition, tell us a little bit about kidney embolization — whether you’ve diagnosed this as an aside from some other test, or there was a reason — tell us a little bit about the treatment options available and why you might choose to do something like an embolization?

Dr. Strup: One of the — again, we don’t have records of what was done or why — but in general, if you have a condition in the kidney — a solid mass in the kidney — one type of solid mass is a fatty tumor called an Angiomyolipoma or an AML. These tumors are growths, just like if you think of fatty growths under your skin, they can happen in the kidney. They tend to contain a lot of fat and also blood vessels, and the blood vessels themselves tend to be very fragile. As those tumors get bigger, what happens is they are at risk to develop spontaneous bleeding either from straining, lifting, or just for no particular reason, they can burst and bleed and cause problems that way. For that condition, they’re not necessarily cancers — one of the reasons that we do embolization of those masses is because you can go in and embolize the blood supply component of that mass. It may not completely shrink away, but you decrease the risk of bleeding. That would be one particular reason that you would do an embolization of a kidney.

Melanie: Now, tell the listeners what is an embolization and how is that procedure done?

Dr. Strup: Well, probably the most recognizable correlation would be — think of heart catheterization. The interventional radiology team, which is usually who would do this, would go in through one of the arteries or veins in the groin, and then they would slide up just like they were going to do a heart catheterization, and then they stop, and they turn, and they go into the kidney arteries. They can inject contrast and get a roadmap, so to speak.

We typically would do that for a mass in the kidney, and you’re trying to see if there is a blood supply there and can that be embolized? If you’re going to embolize it, they’ll use a variety of things. They can use actual blood clot that they can mix up; they can use other particles to embolize or even coils to essentially block the blood flow to that particular mass or area.

Melanie: Dr. Strup, if you do embolize a kidney mass, what is the recurrent rate? Does it come back? Is this something that’s permanent? What is life like? Is it something for the patient that they now have to have checked? Are they more likely to have one come back?

Dr. Strup: Well, again it would really depend on why you’re doing it. There are other instances where you might embolize a mass in the kidney, and let’s say there’s one that you’re worried is cancer. You can embolize that mass. Now, generally, that doesn’t reliably kill the mass, so if you’re concerned it’s cancer, or perhaps you’re very debilitated, and so forth, then you may choose to use that as a treatment consideration. That would be something that would clearly have to be followed and monitored.

For a fatty mass, as we discussed, the AML, generally, you might monitor that from time to time generally to see if the mass is shrinking or going away. Again, if you do a contrast-enhanced image to see if it still is taking up blood flow, that might be a way you can monitor to see if it is still taking up blood flow, then that might be a way you can monitor if it’s developed additional blood vessels and so forth. After an intervention like that, generally there would be some sort of monitoring, but unless it’s for suspected cancer, you would probably just do something either once a year or every other year, and probably something not overly invasive.

Melanie: Wrap it up for us, Dr. Strup. People have been hearing about this now in the media, and they are not really sure what that means, and then people always — when they hear about famous people having these kinds of things, they think to themselves, “What if it’s me? How would I know?” Give us your best advice on kidney issues in general, and what you want the listeners to know about visiting a urologist or spotting some symptoms, looking at their blood work, that sort of thing.

Dr. Strup: Well, I think that generally, starting with good health is a good place to start, so making sure you’re doing all of your health screenings, seeing your physician regularly, getting routine blood checks, getting the urinalysis as part of that physical. Those are basic things that most primary care physicians will do as part of a general health screening.

And then everything sort of falls from there in terms of the subtle things in terms of abnormal blood work or findings in that regard. If there are certain symptoms that crop up — persistent pain in the kidney area, which is toward the back around the side, that would be something to ask their physician about. Certainly, anything that would be related to blood in the urine — especially blood that doesn’t cause pain or anything else — those would be things that you want to bring to your physician’s attention. Generally, that would be something that would be referred to the urologist for further workup.

If, in the course of that workup you’re found to have a mass on the kidney — and again, that could be a simple cyst, atypical cyst, or something solid, that would generally get referred to the urologist for evaluation and then a discussion about A, is this something you need to be concerned about? And B, if it is, what are the options for treatment for an AML or a benign lesion, embolization might be something that is done. That would be just one of the treatment options in a spectrum. I don’t think they need to be overly concerned about needing a kidney embolization. There are usually fairly specific indications as to when they might need that, and it would be an option as a treatment for particular conditions like an AML.

Melanie: Thank you so much, Dr. Strup, for coming on with us and sharing your expertise about this very interesting topic. This is UK Health Cast with the University of Kentucky Healthcare. For more information, you can go to UKHealthcare.UKY.edu, that’s UKHealthcare.UKY.edu. This is Melanie Cole. Thanks so much, for listening.